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' ' OI�lG,rE/4L STATE OF CALIFORNIA SHEET 1 <br /> File Original,Duplicate and Triplicate with the DEPARTMENT OF PUBLIC WORKS <br /> DIYISIOM 1 10 78 VY79 RFSOt1RLES <br /> P.O BtlY DIVISION OF WATER RESOURCES <br /> SACRAMENTO 5 CALIFORNIA ! <br /> Do Not YI In <br /> WATER ,WELL DRILLERS REPORT State Well No�_ ��-`__ <br /> Other WeII No <br /> ' (sectaons 7076,7077,7078,water cone) <br /> -- <br /> Region---- -- ---------------- ---- <br /> (1) Drdler (2) Proposed use or uses (check): (3) Equipment used <br /> Name____L1ark__ Pi l DY'_11�1Ylg fly_ _ _ _ Domestic ❑ Municipal ❑ (check) <br /> Address__2024 F.--ih8.rt-er Wad _-_________________-___ Irrigation ❑ Industrial ❑ Rotary ❑ <br /> __Sto_CktcrL__6y__-Calif._ _____ __ Domesuc and Test well ❑ Cable 9 <br /> License No__7f)602.___..____C12sslfic2t101.S_(; -57 --- Irrigation ❑ Dug well ❑ <br /> ' Other__Air__-Con-dit pining Other___ <br /> Owner <br /> Name_-atacktD3L3tate_Hospital_______ ______ _ (4) Type of work (check) <br /> ' Address__Na t h �`r331f._B to _________________—____ = New well ® Reconditioning of well ❑ <br /> __St.d_CktIIn-r_('+x1 .]_fes ---_ ---------_—__-- Deepening existing well ❑ <br /> (5) Well log: <br /> ' Total depth of well____200 _ ft Give details of formations penetrated, such as silt, peat,muck, sand, gravel, clay, shale, sand- <br /> stone,hardpan,rock Include size of gravel (diameter) and sand (fine, medium, coarse), color <br /> Depth From Ground Surface of material,structure (loose,packed, cemented, soft,hard,brittle) <br /> ' Q__________-_ft to <br /> --2--- --------ft L <br /> am <br /> -__2 -- -------„ ---i---- ---- Adobe <br /> ' -.--6- „»-2Q--------„ — Y w a <br /> - -„ Sand <br /> Yellow elm <br /> Sand <br /> cam__- » _ Gravy, <br /> .1Yell - _ <br /> "___ .��.____ 'IP ow <br /> Blue clay <br /> - ----„ .PP / Sand <br /> "� " Had pan <br /> _.1,1.x.6--_---,1, ,. 156 —„ Sand & gravel <br /> 156 » 200 —„ Blue clay <br /> ,. „ » <br /> 1 —-- <br /> It ,. <br /> » It » <br /> „ „ » <br /> If additional space is required,continue on IM R Form No. 246--57upplement, and attach to respective report copies <br /> (6) Casing left in well: <br /> LENGTH DIAI,IETER SINGLE DOUBLE WELDED LBS PER FOOT OR BEATING BELOW <br /> ' FT INCHES OTHER GAGE OF CASING GROUND SURFACE FT <br /> 200---- —1 ----- ��4>�ble _ - 12 -- - - 200 <br /> --- - --- ----- - - --- -- - -----------__ <br /> Type and size of shoe or well nng_��$.Welded joints—� Yes ❑ No w <br /> ' D W R FORM NO 246 REGIONAL WATER POLLUTION[ CONTROL BOARD COPY 23971, .o,OM QUIP <br /> I <br />